The NASC Workforce Working Group addressing Europe's Anaesthesia Workforce Shortage: Survey Insights and Call to Action 

Urgency of the Issue 

Anaesthesia workforce shortage has become an urgent concern across Europe, with serious implications for patient safety and surgical capacity [1]. No surgery or intensive care unit can function without trained anaesthesia professionals, and staffing gaps are already causing delays and procedure cancellations. This challenge is not unique to Europe – a global shortfall of anaesthesia providers is well recognised – but demographic pressures, post-pandemic burnout, and insufficient capacity in the training pipeline have heightened its impact in European healthcare systems. Recognising the gravity of the situation, the European Society of Anaesthesiology and Intensive Care (ESAIC) and national societies have made workforce sustainability a strategic priority. 

Key Findings from the NASC Survey 

To better quantify and understand these challenges, ESAIC’s National Anaesthesiologists Societies Committee (NASC) conducted a comprehensive survey of anaesthesia practice across Europe. Delegates from 39 countries responded between April 2022 and April 2023, providing a detailed snapshot of the workforce and how anaesthesia services are organised. The results confirmed significant variability in workforce composition, staffing levels, and roles across countries. A majority of countries – over 70% – reported having fewer anaesthesiologists than needed. One caveat, however, is that these figures were based on personal assessments. In the rarest of cases, there are reliable and transparent calculations of the actual staffing requirements. 

The survey highlighted that anaesthesia team structures differ markedly. Some nations rely exclusively on physician anaesthesiologists, whereas about 44% of countries also employ non-physician anaesthesia providers, such as nurse anaesthetists (NPAs), to support care delivery. Training pathways and the autonomy of these providers vary widely, making standardisation difficult. The typical model for intraoperative care is 1 consultant anaesthesiologist per patient (a 1:1 ratio). Still, many countries allow 1 anaesthesiologist to simultaneously supervise 2 patients (1:2 ratio) – or even more – by leveraging residents or NPAs in the theatre. In other words, task-sharing is increasingly used to stretch limited specialist resources. 

The NASC survey also documented disparate staffing levels: the number of anaesthesiologists per 100,000 inhabitants ranges from under 10 in some countries to over 30 in others (Italy, Austria, Cyprus and Germany being at the high end). Significant differences in remuneration and working conditions were also reported, factors that may drive migration and attrition. Overall, the NASC findings underscored that workforce shortages are widespread and that no single solution will fit all countries, given the diverse practice models in use. 

ESAIC Workforce Working Group: Priorities and Projects 

In response to these findings, the NASC has established a Workforce Working Group to engage with this topic systematically and continuously. The group has outlined key focus areas and initial projects to address the topic. Recruitment and retention of new anaesthesiologists is a top priority – making anaesthesia careers more attractive and sustainable through measures such as mentorship programs, improved work-life balance options, and competitive compensation. Closely linked is the imperative to reduce burnout and fatigue: improving working conditions (e.g., well-designed rotas, limits on unsafe hours, adequate rest) to enhance well-being and retain experienced clinicians in the workforce. The Working Group also emphasises optimising team roles and task-sharing: developing frameworks for safe delegation of appropriate tasks to non-physician providers or junior doctors, supported by standardised training and regulation to ensure quality of care. Embracing innovation is another priority, such as leveraging new technology to improve efficiency. 

To turn strategy into action, several projects are already emerging. A pan-European workforce data map is being created to gather and compare national data on staffing levels, distribution, and trends, providing an evidence base for planning. This analysis will also compare anaesthesia workforce indicators with those in surgical disciplines to determine whether the shortages reflect a broader systemic issue or are specific to anaesthesiology. The group is also planning to draft a “Workforce Roadmap” that envisions what a sustainable and resilient European anaesthesia workforce should look like in 5, 10, and 20 years. Additionally, the Working Group is setting up a knowledge-sharing hub where national societies can exchange successful initiatives – for example, innovative retention programs or new care models – so that good ideas can spread more rapidly across borders. Collaboration is central to these efforts: the NASC Working group is coordinating with national societies and European training bodies to align efforts and avoid duplication. The Workforce Working Group aims to serve as “a catalyst and a unifying platform” that – through shared data, shared knowledge, and coordinated advocacy – helps to secure the human resources needed for safe anaesthesia and intensive care now and in the future. 

Germany: An illustrative Case 

By numbers, Germany appears well-staffed – it has one of the highest densities of anaesthesiologists in Europe (over 30 per 100,000) [1] – yet German hospitals are in part struggling to fill anaesthesiology posts and keep up with rising surgical demand. An ageing workforce nearing retirement, an ageing population needing more procedures, increasing rates of part-time work, and provider burnout have created shortfalls even in this relatively well-resourced system. The German Society of Anaesthesiology and Intensive Care Medicine (DGAI) has made workforce sustainability a critical priority, advocating for support for young professionals and improving retention. 

In light of increasing political pressure to transfer activities constituting the practice of medicine to qualified nursing personnel, the DGAI, in collaboration with the German Association of Anaesthetists (BDA), is about to outline a detailed framework identifying clinical activities that may be delegated to non-physician personnel – under defined conditions – explicitly excluding high-risk interventions. The initiative emphasises that all delegated tasks require a medical order, physician supervision, and verified competencies, ensuring that patient safety remains paramount. 

Germany’s experience illustrates that no country is immune to workforce pressures, reinforcing the need for proactive strategies across Europe. 

Broader European and Global Context 

The workforce challenge in anaesthesiology extends beyond any single country. Globally, the WFSA’s latest survey indicates an average of only ~8.8 anaesthesia providers per 100,000 population – far below what is needed for safe surgical care. Many nations remain well under the minimum provider density recommended for adequate access (e.g. <4 per 100,000 in many countries) [2]. Europe is better resourced than some regions, yet many European systems face their own crunch. In the United Kingdom, a shortfall of around 1,900 anaesthetists (~15% of the workforce) is estimated to prevent about 1.4 million operations annually. Without intervention, this UK deficit could reach 11,000 by 2040 [3] – another stark illustration that even high-income systems will struggle to meet surgical demand without workforce expansion. 

At the European policy level, there is growing recognition of the problem. The ESAIC’s recent position paper on building perioperative care resilience [4] explicitly calls out the workforce issue. It states that a well-educated, adequately resourced anaesthesiology workforce is foundational for resilient health systems, warning that even the most cutting-edge advances cannot succeed without sufficient staff. The paper notes that many countries report shortages and overburdened staff, posing risks to patient safety. Among its recommendations is the development of an EU-wide approach to health workforce planning that accounts for anaesthesiology’s specific needs and coordinates with professional societies. Improving working conditions to boost retention, expanding training opportunities, and raising the profile of anaesthesiologists’ vital role in patient care are all highlighted as necessary steps. In sum, European stakeholders are beginning to respond with concrete strategies – but implementation will require political will and investment at both national and EU levels. 

A Call to Action 

Addressing the anaesthesia workforce challenge will require bold, collective action across Europe and beyond. The evidence is clear: without enough anaesthesia providers, surgical and critical care services cannot meet patient needs. Solutions must therefore be equally clear-cut. Training more anaesthesiologists and other anaesthesia professionals is paramount – from increasing residency positions to incentivising young doctors to enter the field. At the same time, protecting the existing workforce is crucial: healthcare systems need to improve working conditions, prevent burnout, and encourage skilled practitioners to remain in clinical practice. Task-sharing models, where appropriate, should be optimised to extend the reach of scarce specialists, while always prioritising patient safety. Crucially, this challenge transcends borders. European institutions, national governments, and professional societies like the ESAIC must work in unison to implement workforce plans and share successful strategies. 

The time for action is now. The anaesthesia community has sounded the alarm; it is incumbent on policymakers and health leaders to heed the call and secure the workforce that underpins safe surgical care for all. 

Author: Carla Nau, NASC representative for Germany and Lead of the NASC Workforce Working Group.

References

1. Pinelli F, Romagnoli S, Singh S, Albaladejo P, Nau C and Bilotta F (2025) Anaesthesia practice in Europe: A survey of the National Anaesthesiologists Societies Committee of the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol 42:189-202 
2. Law TJ, Lipnick MS, Morriss W, Gelb AW, Mellin-Olsen J, Filipescu D, Rowles J, Rod P, Khan F, Yazbeck P, Zoumenou E, Ibarra P, Ranatunga K, Bulamba F and Collaborators (2024) The Global Anesthesia Workforce Survey: Updates and Trends in the Anesthesia Workforce. Anesth Analg 139:15-24 
3. Kunzmann P, Wallwork A (2024) The Anaesthetic Workforce: UK State of the Nation Report November 2024. © 2024 Royal College of Anaesthetists, ISBN: 978-1-900936-37-8  
4. Buhre W, Matot I, Ringvold EM, Shick ON, Berger-Estilita J, Klimek M, Coburn M, Struys M, Camilleri-Podesta AM, Ateleanu B, Brazzi L, Guasch E, Sabelnikovs O Weynants C (2025) Building resilience in perioperative medicine: ensuring safe care for all. A White Paper from the European Society of Anaesthesiology and Intensive Care (ESAIC). ESAIC, Rue des Comédiens 24, 1000 Bruxelles